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Mental health issues in children are increasing. One in five kids now suffer from a mental disorder, according to a recent report from the Centers for Disease Control and Prevention.

These mental health disorders include commonly known illnesses like depression or ADHD. But there are also mental health issues that are rarely associated with elementary schoolers, like Obsessive Compulsive Disorder.

Cassidy George is 10 years old. From as early as she can remember, she has had a lot of fears. “I didn't like the dark,” said George. “I didn’t like to go around and talk to people.”

Cassidy’s mother, Lisa, is a first grade teacher in Santa Monica. She began noticing her daughter's anxious behavior when Cassidy was a toddler. Cassidy meticulously collected leaves and rocks in jars and buckets. But when it was time to empty the bucket, Lisa remembers Cassidy would get “very distressed.”

Then Lisa started noticing things at home, like Cassidy lining up her stuffed animals in her bed. “Before she went to bed,” Lisa George said, “they had to all be in place, and they had to be in a particular order, in order for her to get into bed and go to sleep.”

Lisa George sought help for her daughter. At age 7, Cassidy was diagnosed with Obsessive Compulsive Disorder at Jenny Yip’s Renewed Freedom Center. She has been treated there ever since. OCD is an anxiety disorder that strikes one in 200 children. That’s twice the number of children with diabetes.

Yip is a psychologist and clinical assistant professor of psychiatry in the USC school of medicine. The Renewed Freedom Center is a clinic she runs to treat mental illness. Yip has treated children as young as 2 or 3 for OCD, but most often, she said, OCD in children presents after 5 years of age.

Difficult to express

It can be hard for children to articulate what they are experiencing, Yip said: “It’s almost like you’re having a nightmare that you’re replaying in your mind over and over that you cannot stop.”

According to Yip, a person can be genetically vulnerable to OCD but may never develop symptoms. Most often, something stressful triggers the anxiety.

Once symptoms develop, there are generally two types of treatment: medication and cognitive behavioral therapy. CBT teaches patients how to control their thoughts when anxiety hits.

Cognitive behavioral therapy as a treatment for children with OCD is also practiced by Pacific Clinics, a mental health services agency that has over twenty years working with students at various school districts to provide therapy and services.

Nicole Starace is a Pacific Clinics therapist who works at schools in the Alhambra Unified School District. She uses Exposure and Response Prevention therapy for her students who have anxiety issues.

Starace said this therapy helps a child with a fear of contamination; for example, by “exposing” the child to their fear. She will deliberately, and gently, place the child in the “situation that makes them fearful” as a first step to helping the child deal with the anxiety.

Yip recently co-authored an article that was published in the Journal of Psychiatric Research that found that CBT treatment for OCD “regularly yields therapeutic responses that rival or exceed those of drug treatments.”

The study was based on an adult population, but Yip said that children, too, can benefit from therapy. “By doing CBT it actually changes the neurochemistry of your brain, it actually builds new neuro pathways,” she said.

Controlling emotions

Children experience anxiety as part of their development. Learning to control emotions is part of normal early childhood behavior, said Joyce Green, an L.A-based infant mental health specialist. She said children will often having difficulty “regulating themselves or calming themselves or self soothing.” This behavior may “look like” OCD, Green said, but it’s actually the child’s “attempt to self regulate.”

Green advises parents to help children soothe and calm themselves. If the anxiety continues and a child has “nightmares, or they begin self-harming behavior,” Green said parents should seek help.

There is a greater awareness in schools today of mental illness in children. Tonya El Hendi works at the Gateway to Success program in the Alhambra school district. Gateway provides on campus mental health services to students. This school year Gateway has served 10 percent of Alhambra USD students through classroom sessions and one-on-one counseling services when a student displays behaviors that might indicate a mental illness.

Yet El Hendi and other therapists frequently meet resistance from parents due to what El Hendi calls the “stigma” attached to mental health issues.

To deal with this, the program frames itself simply as “additional support services” for students. El Hendi said this allows her and other therapists to help students “actually do better in the academic realm.”

It’s something that Garfield Elementary Principal Anna Quo recognizes, too. She has seen kindergarten students debilitated by anxieties and also those who “are so hyperactive that we can’t contain them.”

Too often these kids end up in the principal’s office with “discipline issues,” according to Joe Ho, the Division Director of Pacific Clinics. He says it is critical that teachers and parents be on the look out for signals of possible mental health issues.

His strategy is simple: “We like to catch them early.”

Early diagnosis can lead to treatment and therapy that will help children deal with fears or depression and do better in school, Ho said. He advocates for holistic strategies like educating parents and conducting family therapy for a child’s mental health issue.

Quo of Garfield Elementary likes this strategy. “Without dealing with the mental health we cannot deal with the academics,” Quo said.